This initiative is designed to evaluate and improve the quality of screening and diagnostic colonoscopies in ambulatory care settings. Using the Clinical Outcomes Research Initiative (CORI) consortium and the National Endoscopic Database (NED) we will develop and test the Excellence Report, a quality report card for gastrointestinal (GI) endoscopy, focusing on nationally-recognized quality process measures for colonoscopy. After development of the Excellence Report, we will evaluate it using both qualitative and quantitative methodologies. Using a clustered randomized trial design, CORI-affiliated clinicians working in ambulatory care centers or offices will receive monthly reports of their quality measures along with comparisons to other CORI clinicians and to national benchmarks. The effect both on reporting of quality measures data and on adherence to the quality recommendations will be measured along with the durability of changes upon ceasing the reports. Concurrently, field observations and interviews will be performed with a representative sample of clinicians who are receiving the Excellence Report. Based on these observations and interviews, a survey will be created and administered to all participating clinicians. We will learn about the perceptions of the clinicians of reliability and validity of the data that are presented, their acceptance of the quality initiative, and we will look for effects on workflow and for any unintended consequences of the Excellence Report. Concurrent with this development and evaluation activity, this initiative will support a workgroup of GI reporting software vendors, imaging system vendors and GI pathology laboratories along with the GI specialty societies on development of a sustainable and standards based architecture that will allow the Excellence Report to expand beyond CORI. [unreadable] [unreadable] [unreadable] [unreadable]